Endonasal Microdebrider Assisted Excision of Congenital Intranasal Nasolacrimal Duct Cyst or Inferior Mucocoele.

OBJECTIVE: Congenital intranasal nasolacrimal duct (NLD) cyst is a rare clinical entity in the newborn whilst inferior mucocoeles are more common. We reviewed our case series of the management of patients presenting with congenital intranasal NLD cysts and inferior mucocoeles treated using powered instrumentation under endoscopic guidance. METHODS: A retrospective review identified three patients, between 2010 and 2013, who have had microdebrider assisted endoscopic marsupialisation of congenital intranasal NLD cysts under joint ENT and Ophthalmology care. RESULTS: Diagnosis was made based on intraoperative endoscopic nasal examination carried out during treatment of patients with epiphora. All patients were 2 years old or younger presented with persistent epiphora since birth with sticky eyes. All had normal development with no other past medical history of note. Two patients had unilateral and one patient had bilateral congenital intranasal NLD cysts/inferior mucocoels identified. These were treated by endoscopic incision of the cyst with drainage of pus and excision of excess mucosal tissue using a powered microdebrider to effect marsupialisation and prevent re healing of the floppy redundant flaps of the incised cyst. No silastic tubes were placed. All patients were discharged from clinic 3 months post surgery with complete resolution of symptoms and no complications. CONCLUSIONS: Microdebrider assisted endoscopic marsupialisation is a safe and effective treatment for removal of excess tissue in the treatment for congenital intranasal NLD cyst/inferior mucocoele whilst also obviating the need for silastic intubation and a further general anaesthetic for stent removal.

Patient information leaflet on mastoid surgery risks: assessment of readability and patient understanding.

INTRODUCTION: It is important that patients have a good understanding of surgery-related risks, particularly for mastoid surgery, which exposes patients to the risk of very serious complications, despite addressing conditions which often have only minor symptoms. MATERIALS AND METHODS: A patient information leaflet describing the risks of mastoid surgery was prepared. However, the Hospital Patient Advice and Liaison Services team thought it was too long and complicated. It was introduced unchanged. Fifty-four consecutive mastoidectomy patients were given a questionnaire asking for their opinion of the leaflet. The leaflet was also assessed with readability formulae and the Ensuring Quality Information for Patients tool. RESULTS AND ANALYSIS: Ninety-eight per cent of respondents thought the leaflet's writing style was easy to understand. The majority (96 per cent) thought the length was 'just right'. The 7 readability formulae used established readability at a grade 9 level (i.e. appropriate for a reading age of 13-15 years). The Ensuring Quality Information for Patients score was 87.5 per cent. DISCUSSION: Despite the drive to simplify patient information leaflets, quite detailed information is sometimes required. A style which is too simple may be perceived as patronising and may encourage patients to underestimate potential risks. It is important to ask patients their opinion.

Idiopathic oesophageal dysmotility disorder: stridor secondary to megaesophagus.

We present an interesting case of an elderly lady who presented with stridor caused by megaesophagus secondary to an acquired idiopathic dysmotility disorder. We discuss the aetiology and management of megaesophagus secondary to this condition and how it differs from megaesophagus secondary to achalasia.

Non-voice-related throat symptoms: comparative analysis of laryngopharyngeal reflux and globus pharyngeus scales.

BACKGROUND: This study calculated the comparability of two throat symptom assessment scales devised to evaluate either laryngopharyngeal reflux or globus. SETTING: United Kingdom hospital out-patient departments. METHOD: A total of 334 subjects, with and without throat symptoms, completed the Reflux Symptom Index and/or the Glasgow and Edinburgh Throat Scale. The following were calculated for the resultant data: Cronbach's α coefficient, principal component analysis, Kaiser normalisation, varimax and oblimin rotation, and eigenvalues. RESULTS: Analysis of data from the Reflux Symptom Index and the Glasgow and Edinburgh Throat Scale revealed clearly similar symptom domains regarding (1) coughing and blockage, and (2) globus or postnasal drip or throat-clearing, as did combined analysis of their amalgamated items. Both instruments had good overall internal consistency (α = 0.75 and 0.81, respectively). The 'heartburn or reflux' item in the Reflux Symptom Index mapped poorly to each underlying factor. DISCUSSION: The most commonly used laryngopharyngeal reflux and globus assessment questionnaires appear to detect very similar symptom clusters. The management of throat disorders may previously have been over-reliant on the presenting pattern of throat symptoms. Our findings indicate a need to revisit the traditional clinical classification of throat symptoms.